微创穿刺碎吸术治疗高血压脑出血颅内血肿120例的疗效观察与价值评价
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摘要
目的探讨分析微创穿刺碎吸术治疗高血压脑出血颅内血肿的临床效果。方法根据患者头颅CT按多田计算方式计算脑出血血肿量,选取2014年6月～2017年6月我院中有手术指征,除外合并脑疝必须行开颅手术的,愿意接受手术治疗的患者240例,随机将240例患者分为两组:实验组(微创穿刺碎吸术治疗)、对照组(开颅血肿清除术治疗),每组120例。观察脑出血颅内血肿患者的临床效果,针对其血肿清除率、格拉斯哥预后评分(GOS评分)、改良Rankin量表评分(mRS)、日常生活能力量表-巴氏指数(BI)、生存率、平均住院时间、再发生出血率进行比较。结果经治疗,实验组GOS评分、mRS、BI均优于对照组,且住院时间短,血肿清除率较对照组高,实验组仅有1例出现颅内继发性再出血,与对照组相比,差异有统计学意义(P <0.05)。结论微创穿刺碎吸术应用于高血压脑出血颅内血肿具有非常好的临床效果,其可以缩短患者的住院时间,有利于患者的治疗和康复。
Objective To explore the clinical effect of minimally invasive puncture and aspiration in the treatment of hypertensive cerebral hemorrhage intracranial hematoma. Methods The amount of hematoma in cerebral hemorrhage was calculated by multi-field calculation according to patients' head CT.240 patients who were willing to undergo surgery and had indications for surgery in our hospital from June 2014 to June 2017 were selected,except for those with cerebral hernia.The 240 patients were divided into two groups randomly,the experimental group(treated by minimally invasive puncture and aspiration) and the control group(treated by craniotomy hematoma evacuation),each group had 120 cases.The clinical efficacy was observed, hematoma clearance rate,Glasgow prognosis score(GOS score),modified Rankin scale score(mRS), activity of daily living scale-Barr's index(BI),survival rate,average length of stay,recurrence bleeding rate were compared. Results After treatment,the GOS score,mRS and BI of the experimental group were better than the control group,and the hospitalization time was shorter,the hematoma clearance rate was higher than the control group.There was only one case of secondary intracranial rebleeding in the experimental group,compared with the control group,the difference was statistically significant(P < 0.05).Conclusion The application of minimally invasive puncture and aspiration in the treatment of hypertensive cerebral hemorrhage intracranial hematoma has a very good clinical effect.It can shorten the patient's hospitalization time and be beneficial to the treatment and rehabilitation of the patients.
Objective To explore the clinical effect of minimally invasive puncture and aspiration in the treatment of hypertensive cerebral hemorrhage intracranial hematoma. Methods The amount of hematoma in cerebral hemorrhage was calculated by multi-field calculation according to patients' head CT.240 patients who were willing to undergo surgery and had indications for surgery in our hospital from June 2014 to June 2017 were selected,except for those with cerebral hernia.The 240 patients were divided into two groups randomly,the experimental group(treated by minimally invasive puncture and aspiration) and the control group(treated by craniotomy hematoma evacuation),each group had 120 cases.The clinical efficacy was observed, hematoma clearance rate,Glasgow prognosis score(GOS score),modified Rankin scale score(mRS), activity of daily living scale-Barr's index(BI),survival rate,average length of stay,recurrence bleeding rate were compared. Results After treatment,the GOS score,mRS and BI of the experimental group were better than the control group,and the hospitalization time was shorter,the hematoma clearance rate was higher than the control group.There was only one case of secondary intracranial rebleeding in the experimental group,compared with the control group,the difference was statistically significant(P < 0.05).Conclusion The application of minimally invasive puncture and aspiration in the treatment of hypertensive cerebral hemorrhage intracranial hematoma has a very good clinical effect.It can shorten the patient's hospitalization time and be beneficial to the treatment and rehabilitation of the patients.
引文
[1]俞正勇.微创穿刺碎吸术应用在脑出血颅内血肿治疗中的临床价值[J].中外医疗,2017,36(24):112-114.
[2]胡玉平,章驰.微创穿刺碎吸术治疗脑出血颅内血肿45例临床观察[J].中国民族民间医药,2015,24(14):75-76.
[3]陆川,林建虎,巴华君,等.微创穿刺清除术在基底节区脑出血治疗中的临床应用研究[J].中国医师进修杂志,2012,35(11):25-27.
[4]Dowlatshahi D,Butcher KS,Asdaghi N.et al.Poor prognosis in warfarin-associated intracranial hemorrhage despite anticoagulation reversal[J].Stroke:A Journal of Cerebral Circulation,2012,43(7):1812-1817.
[5]康芳钦.颅内血肿微创穿刺清除术治疗高血压性脑出血65例临床观察[J].实用临床医学,2012,13(1):32-33.
[6]聂新来.微创血肿碎吸术治疗高血压脑出血的效果分析[J].实用心脑肺血管病杂志,2014,22(8):77-78.
[7]Jaroszewski DE,Johnson K,McMahon L,et al.Sternal elevation before passing bars:A technique for improving visualization and facilitating minimally invasive pectus excavatum repair in adult patients[J].The Journal of Thoracic and Cardiovascular Surgery,2014,147(3):1093-1095.
[8]王宏,王顺超,何杰,等.颅内血肿微创碎吸术治疗高血压脑出血效果探讨[J].中外医学研究,2016,14(33):27-28.
[9]楼菊娟,阮世宏,汤蓉等.高血压脑出血微创颅内血肿清除术后的观察和护理[J].全科医学临床与教育,2014,12(6):699-700.
[10]唐韬,胡国良.亚低温联合穿刺碎吸术治疗高血压脑出血的疗效[J].中国临床神经外科杂志,2016,21(3):147-149.
[11]吴宪,宋益洲,李忠娟,等.老年高血压脑出血实施急诊微创手术治疗的效果观察[J].中国现代医生,2017,55(15):81-83.
[12]Shuaib SW,Hutcheson KA,Knott JK.et al.Minimally invasive approach for the management of the leaking tracheoesophageal puncture[J].The Laryngoscope:AMedical Journal for Clinical and Research Contributions in Otolaryngology,Head and Neck Medicine and Surgery,Facial Plastic and Reconstructive Surgery,2012,122(3):590-594.
[13]Kazumata K,Shinbo D,Ito M,et al.Spatial relationship between cerebral microbleeds,moyamoya vessels,and hematoma in moyamoya disease[J].Journal of stroke and cerebrovascular diseases:The official journal of National Stroke Association,2014,23(6):1421-1428.
[14]牛玉洁.开颅血肿清除术与血肿碎吸术治疗高血压脑出血的临床效果对比[J].河南医学研究,2014,23(9):119-121.
[15]程华.87例急性脑出血微创穿刺治疗的临床分析[J].中外医疗,2012,31(36):98,100.
[2]胡玉平,章驰.微创穿刺碎吸术治疗脑出血颅内血肿45例临床观察[J].中国民族民间医药,2015,24(14):75-76.
[3]陆川,林建虎,巴华君,等.微创穿刺清除术在基底节区脑出血治疗中的临床应用研究[J].中国医师进修杂志,2012,35(11):25-27.
[4]Dowlatshahi D,Butcher KS,Asdaghi N.et al.Poor prognosis in warfarin-associated intracranial hemorrhage despite anticoagulation reversal[J].Stroke:A Journal of Cerebral Circulation,2012,43(7):1812-1817.
[5]康芳钦.颅内血肿微创穿刺清除术治疗高血压性脑出血65例临床观察[J].实用临床医学,2012,13(1):32-33.
[6]聂新来.微创血肿碎吸术治疗高血压脑出血的效果分析[J].实用心脑肺血管病杂志,2014,22(8):77-78.
[7]Jaroszewski DE,Johnson K,McMahon L,et al.Sternal elevation before passing bars:A technique for improving visualization and facilitating minimally invasive pectus excavatum repair in adult patients[J].The Journal of Thoracic and Cardiovascular Surgery,2014,147(3):1093-1095.
[8]王宏,王顺超,何杰,等.颅内血肿微创碎吸术治疗高血压脑出血效果探讨[J].中外医学研究,2016,14(33):27-28.
[9]楼菊娟,阮世宏,汤蓉等.高血压脑出血微创颅内血肿清除术后的观察和护理[J].全科医学临床与教育,2014,12(6):699-700.
[10]唐韬,胡国良.亚低温联合穿刺碎吸术治疗高血压脑出血的疗效[J].中国临床神经外科杂志,2016,21(3):147-149.
[11]吴宪,宋益洲,李忠娟,等.老年高血压脑出血实施急诊微创手术治疗的效果观察[J].中国现代医生,2017,55(15):81-83.
[12]Shuaib SW,Hutcheson KA,Knott JK.et al.Minimally invasive approach for the management of the leaking tracheoesophageal puncture[J].The Laryngoscope:AMedical Journal for Clinical and Research Contributions in Otolaryngology,Head and Neck Medicine and Surgery,Facial Plastic and Reconstructive Surgery,2012,122(3):590-594.
[13]Kazumata K,Shinbo D,Ito M,et al.Spatial relationship between cerebral microbleeds,moyamoya vessels,and hematoma in moyamoya disease[J].Journal of stroke and cerebrovascular diseases:The official journal of National Stroke Association,2014,23(6):1421-1428.
[14]牛玉洁.开颅血肿清除术与血肿碎吸术治疗高血压脑出血的临床效果对比[J].河南医学研究,2014,23(9):119-121.
[15]程华.87例急性脑出血微创穿刺治疗的临床分析[J].中外医疗,2012,31(36):98,100.